Promising alternative to hepatic islet transplantation reported

medwireNews: Researchers have shown that donor islet cells can be transplanted to the omentum of type 1 diabetes patients, avoiding the transplant-tissue volume restrictions and risks for bleeding and blood-mediated inflammatory responses associated with hepatic transplantation.

The omentum (a layer of peritoneum) “has a dense vascularized surface for islet implantation, drains into the portal system, and is easily accessible,” according to David Baidal (University of Miami Leonard M. Miller School of Medicine, Florida, USA) and co-researchers.

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As described in The New England Journal of Medicine, the team transplanted donor islet cells into the omentum of a 43-year-old woman with a 25-year history of type 1 diabetes who had hypoglycemic unawareness and severe hypoglycemia. They layered the donor cells with recombinant thrombin and the patient’s own plasma “to generate a degradable biologic scaffold.”

The patient stopped insulin 17 days later. Between 6 and 12 months, her insulin secretion declined and her glucose levels rose, which the researchers believe was due to a change in her immunosuppressive regimen (tacrolimus to sirolimus, because of hair loss). Nevertheless, she remained free of insulin 12 months after transplantation. Her glycated hemoglobin level was 6.0%, which in combination with her fasting C-peptide level and fasting glucose level indicated a low likelihood of glucose intolerance.

The researchers also note, however, that the patient “exercised regularly and followed a low-carbohydrate diet, which probably contributed to her stable glycemic control.”